Involved-Field Radiotherapy May Be Best Option for Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma


Key Points

  • Progression-free survival was similar with combined-modality treatment, extended-field radiotherapy, and involved-field radiotherapy patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma.
  • Relapse risk was higher with rituximab alone vs other options.

As reported by Eichenauer and colleagues in the Journal of Clinical Oncology, an analysis of long-term outcomes suggests that involved-field radiotherapy may be the best treatment option in patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma.

Study Details

The study involved 256 patients (median age at diagnosis = 39 years, 76% male) treated in German Hodgkin Study Group studies between 1988 and 2009. Patients had received combined-modality treatment (n = 72), extended-field radiotherapy (n = 49), involved-field radiotherapy (n = 108), or four weekly standard doses of rituximab (Rituxan, n = 27).

Median follow-up was 91 months in the total population, 95 months in patients receiving combined-modality treatment, 110 months in those receiving extended-field radiotherapy, 87 months in those receiving involved-field radiotherapy, and 49 months in those receiving rituximab.

Long-Term Outcomes

The 8-year progression-free survival rate was 88.5% with combined-modality treatment, 84.3% with extended-field radiotherapy, and 91.9% with involved-field radiotherapy, and the 4-year progression-free survival rate with rituximab was 81.0%. Eight-year overall survival was 98.6% with combined-modality treatment, 95.7% with extended-field radiotherapy, and 99.0% with involved-field radiotherapy, and 4-year overall survival with rituximab was 100%.

A second malignancy occurred in 17 patients (6.6%) during follow-up. Of the total of 12 deaths, only 1 was due to nodular lymphocyte-predominant Hodgkin lymphoma.

The investigators concluded: “Tumor control in this analysis was equivalent with [combined-modality treatment, extended-field radiotherapy, and involved-field radiotherapy]. Therefore, [involved-field radiotherapy], which is associated with the lowest risk for the development of toxic effects, should be considered as standard of care for patients with stage IA [nodular lymphocyte-predominant Hodgkin lymphoma]. Rituximab alone is associated with an increased risk of relapse in this patient population.”

Andreas Engert, MD, of University Hospital Cologne, is the corresponding author for the Journal of Clinical Oncology article.

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